Job Summary

Monitors work transactions which may include calls, correspondence, claims, adjustments, enrollments, terminations, reconciliations; Maintains quality scores reporting,  compares results and trends with standards, controls and procedures; Assists in the identification of specific training needs and opportunities for quality and accuracy improvement to increase customer satisfaction.
This is a bargaining unit position.  The collective bargaining agreement for this position requires that candidates and employees reside in the following counties in the State of New York: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, or Wyoming.
 

Duties Note: The following is not intended to be an exhaustive list of all duties required of this position.
ADA
E1. Reviews, documents and scores individual transactions for quality and accuracy; communicates individual departmental performance data to management: •Monitors and documents transactions as performed, according to established quality standards and best business practices •Maintains knowledge of policies and procedures, products and processes; additionally maintains a clear understanding of current, revised or newly implemented applicable state, federal and accrediting agency requirements •Provides timely, clearly and concisely written, verbal and/or electronic feedback regarding quality and accuracy on all completed evaluations •Provides individual and SBU/Corporate Support Functions (CSF) performance reports to assist in identifying trends and training opportunities to improve customer satisfaction and quality of transactions
E2. Coaches staff to address errors identified during review
E3. Maintains Quality reports; assists in identification of root causes of noted issues and makes recommendations to correct problems: •Participates in and contributes to various department meetings, as assigned
E4. Schedules and facilitates calibration sessions and demonstrates monitoring skills consistent with peers and corporate standards: •Schedules calibration session, selects transactions for session review, collects completed Quality Observation Forms (QOF) from session participants, maintains session notes, and leads computer setup
E5. Identifies, notifies, and/or assists appropriate management in the development, implementation and support of operational policies, procedures and desk levels
E6. Performs all job duties efficiently, accurately and at an acceptable rate of performance
N7. Performs related clerical duties: •Files, faxes, copies documents
E8. Maintains confidentiality and adheres to HIPAA regulations
E9. Delivers customer service in a professional, polite and efficient manner
N10. Performs other duties of a similar nature that are necessary and not inconsistent with this position or pay grade

Education/Experience/Skills Requirements
Required Education:
Associates Degree:

Required Experience:
Minimum of 2 years in membership/billing, claim processing, customer service or quality related work

Preferred Education:
HS/GED

Preferred Experience:
Minimum of 2 years in membership/billing, claim processing, customer service; Must have a proven record of high quality performance maintaining acceptable levels of productivity and quality measures

Required Experience:
Related college courses in lieu of some of the experience. *Position requires an interview process

Preferred Education:
Associates Degree: Business Admin., Healthcare Administration


Required Knowledge/Skills:
1. Must meet qualifications to perform the job including satisfactory completion of all training and testing
2. Ability to multitask in fast paced environment
3. Ability to research and investigate from multiple sources; evaluate information and reach sound logical conclusions
4. Well organized with ability to adapt to changing office environment; exhibits attention to details and time management skills
5. Proficiency in English language skills, including spelling, punctuation and grammar, in both written and verbal communication to ensure communications are issued in a professional manner
6. Ability to effectively communicate in both written and verbal communication with internal and external contacts, in a professional manner
7. Working knowledge of personal computer and application software such as Microsoft Office
8. Ability to utilize basic office equipment including PC, scanner, telephone and headset, copier, printer, fax, calculator
9. Computer Software typically used: Facets/Streamline, Word, Excel, Content Manager
Required Licenses/Certifications:
Problem Solving
Identifies key facts and relevant data; researches appropriate information; identifies issues, problems and inconsistencies; seeks relationships, organizes information; compares, contrasts and/or combines information as appropriate.
Managerial/Supervisory Responsibilities
Does this Position have Supervisory Responsibility? No
Number of Emps Supervised:
Titles of Employees Supervised:
Financial/Budgetary Responsibilities:
Other Job Specifications:
External Contacts: Auditors, Vendors
Working Conditions/Physical Demands:
Position requires:
* Must be able to work in an office environment
Position involves:
* Physical Effort: Minimum; typical of most office work. Mostly sedentary work.
* Weight: lift/carry/push/pull under 10 lbs.
* Prolonged Sitting
* Repetitive Motion
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)
* Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
* Vision Req: Close vision (clear vision at 20 inches or less)

Pay Rate:

The starting hourly rate for this position listed above is for new employees. This rate has been established by the Local 153, Office and Professional Employee International Union (OPEIU) collective bargaining agreement (CBA) and is non-negotiable. If the successful candidate is currently a bargaining unit member of the OPEIU, hourly rate is commensurate with their anniversary year and pay grade as per the CBA.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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